Robert McDowell Topics in Geriatrics: Aquatic Therapy vs. Land Therapy in Parkinson’s Disease
There are several land-based programs and interventions established for patients with Parkinson’s disease that have been shown to be beneficial. However, studies have recently begun to show promise for aquatic therapy as an effective intervention technique as well to enhance the functional mobility of patients with Parkinson’s disease.
Objectives:
The objectives of this page are to:
Learn about the pros and cons of aquatic therapy for patients with Parkinson’s Disease
Learn about what separates aquatic therapy from land therapy
Learn about the evidence related to aquatic therapy for patients with Parkinson’s Disease
Discover what parameters of aquatic therapy are best for this population
Learn where and when to use aquatic therapy
Information About Aquatic Therapy for Parkinson’s disease
Benefits of Aquatic Therapy
Statistically significant improvements in motor function and fitness level as measured by the UPDRS, PDQ-39, and Fullerton Fitness Test.1
Buoyancy and hydrostatic pressure properties of water allow support of the patient to decrease velocity of falls and therefore their fear of falling during therapy.1,2
Warm water may improve spasticity and postural stability.1
Higher intensity aquatic strengthening exercises significantly improved Five Time sit-to-stand times and UPDRS scores compared to low intensity aquatic exercise group.2
o Higher intensity group: 2x/week for 12 weeks. Warm-up, 6 dynamic sub-max exercises of 2-3 sets of 15 reps each, and a cool down.2
Aquatic therapy can improve lower extremity range of motion, gait speed, stride length, and stance: swing phase relationship in patients with Parkinson’s disease.3
Watsu improved sleep quality, duration, and daytime dysfunction compared to traditional land physical therapy.4
Utilization of the 10-step Halliwick concepts in aquatic therapy significantly improved rotational mobility and quality of life in patients with Parkinson’s disease.5
Aquatic vs. Land Therapy
Performed the same exercises, intensities, and frequencies with land group and aquatic group.6
These exercises targeted trunk mobility, postural stability, and sit<>stand.6
Both intervention methods improved postural stability and functional reach.6
Aquatic therapy significantly improved Berg and UPDRS scores compared to land therapy.6
How and to whom do I implement aquatic therapy?
Although current research is limited to small sample studies such as the ones referenced below, there is sufficient evidence to implement aquatic therapy interventions with patients with Parkinson’s disease who do not have other contraindications to participate in aquatic therapy.
A warmer pool (820-900 F) should be used to promote relaxation of rigidity.6
Pools for aquatic therapy use can be accessed in particular clinics, hospitals, gymnasiums, YWCAs and YMCAs.
o Further consultation will be required if the pool is off-site
Perform higher intensity resistive exercises and exercises that challenge rotational mobility and postural stability.2
Utilize for patients with Parkinson’s disease to improve quality of life, sleep, and functional mobility.1,2,3,4,5,6
Evidence for Use of the Aquatic Therapy
The current evidence for aquatic therapy for use in patients with Parkinson’s disease is currently limited, and requires future studies with greater strength. However, the studies briefly summarized above are linked below and demonstrate the wide-range of benefits examined thus far.
2. Ayán, Carlos, and José Cancela. "Feasibility of 2 Different Water-Based Exercise Training Programs in Patients With Parkinson's Disease: A Pilot Study." Archives of Physical Medicine and Rehabilitation 93.10 (2012): 1709-714. Print.
3. Rodriguez, P., Cancela, J., Ayan, C., do Nascimento, C., & Seijo-Martinez, M. (2013). Effects of aquatic physical exercise on the kinematic gait pattern in patients with parkinson's disease: A pilot study. Revista De Neurologia, 56(6), 315-320.
4. Loureiro, A., Burkot, J., Oliveira, J., & Barbosa, J. (2014). Aquatic physical therapy for parkinson's disease patients to improve quality of sleep. MOVEMENT DISORDERS, 29, S294-S294.
5. Loureiro, A. P. C., Gnoato, T. G., Viana, J. R., Cidade, L., Sabino, J., & Cruz, L. (2009). P3.167 aquatic physical therapy approach, using principles of halliwick concept, for improvement of aquatic motor skills, among parkinson's disease patients. Parkinsonism and Related Disorders, 15, S191-S191. doi:10.1016/S1353-8020(09)70731-X
Topics in Geriatrics: Aquatic Therapy vs. Land Therapy in Parkinson’s Disease
There are several land-based programs and interventions established for patients with Parkinson’s disease that have been shown to be beneficial. However, studies have recently begun to show promise for aquatic therapy as an effective intervention technique as well to enhance the functional mobility of patients with Parkinson’s disease.
Objectives:
The objectives of this page are to:
Information About Aquatic Therapy for Parkinson’s disease
Benefits of Aquatic Therapy
- Statistically significant improvements in motor function and fitness level as measured by the UPDRS, PDQ-39, and Fullerton Fitness Test.1
- Buoyancy and hydrostatic pressure properties of water allow support of the patient to decrease velocity of falls and therefore their fear of falling during therapy.1,2
- Warm water may improve spasticity and postural stability.1
- Higher intensity aquatic strengthening exercises significantly improved Five Time sit-to-stand times and UPDRS scores compared to low intensity aquatic exercise group.2
- o Higher intensity group: 2x/week for 12 weeks. Warm-up, 6 dynamic sub-max exercises of 2-3 sets of 15 reps each, and a cool down.2
- Aquatic therapy can improve lower extremity range of motion, gait speed, stride length, and stance: swing phase relationship in patients with Parkinson’s disease.3
- Watsu improved sleep quality, duration, and daytime dysfunction compared to traditional land physical therapy.4
- Utilization of the 10-step Halliwick concepts in aquatic therapy significantly improved rotational mobility and quality of life in patients with Parkinson’s disease.5
Aquatic vs. Land TherapyHow and to whom do I implement aquatic therapy?
Evidence for Use of the Aquatic Therapy
References
1. C. Ayán, J.M. Cancela, Effects of aquatic exercise on persons with Parkinson's disease: A preliminary study, Science & Sports, Volume 27, Issue 5, November 2012, Pages 300-304, ISSN 0765-1597, http://dx.doi.org/10.1016/j.scispo.2011.12.006. (http://www.sciencedirect.com/science/article/pii/S0765159711002401)
2. Ayán, Carlos, and José Cancela. "Feasibility of 2 Different Water-Based Exercise Training Programs in Patients With Parkinson's Disease: A Pilot Study." Archives of Physical Medicine and Rehabilitation 93.10 (2012): 1709-714. Print.
3. Rodriguez, P., Cancela, J., Ayan, C., do Nascimento, C., & Seijo-Martinez, M. (2013). Effects of aquatic physical exercise on the kinematic gait pattern in patients with parkinson's disease: A pilot study. Revista De Neurologia, 56(6), 315-320.
4. Loureiro, A., Burkot, J., Oliveira, J., & Barbosa, J. (2014). Aquatic physical therapy for parkinson's disease patients to improve quality of sleep. MOVEMENT DISORDERS, 29, S294-S294.
5. Loureiro, A. P. C., Gnoato, T. G., Viana, J. R., Cidade, L., Sabino, J., & Cruz, L. (2009). P3.167 aquatic physical therapy approach, using principles of halliwick concept, for improvement of aquatic motor skills, among parkinson's disease patients. Parkinsonism and Related Disorders, 15, S191-S191. doi:10.1016/S1353-8020(09)70731-X
6. Jamile Vivas, Pablo Arias, Javier Cudeiro, Aquatic Therapy Versus Conventional Land-Based Therapy for Parkinson's Disease: An Open-Label Pilot Study, Archives of Physical Medicine and Rehabilitation, Volume 92, Issue 8, August 2011, Pages 1202-1210, ISSN 0003-9993, http://dx.doi.org/10.1016/j.apmr.2011.03.017. (http://www.sciencedirect.com/science/article/pii/S0003999311001900)